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'''For the WikiDoc page for this topic, click [[Hepatitis C|here]]'''
'''For the WikiDoc page for this topic, click [[Hepatitis C|here]]'''
{{Hepatitis C (patient information)}}


{{CMG}}
{{CMG}}; {{AE}} {{JS}}
 
==Overview==
[[Hepatitis C]] is a contagious [[liver disease]] caused by the [[hepatitis C virus]]: the [[virus]] can cause both acute and [[chronic hepatitis]] [[infection]], ranging in severity from a mild illness, lasting a few weeks to a serious, lifelong illness. The [[hepatitis C virus]] is a bloodborne virus and the most common modes of [[infection]] are through unsafe injection practices; inadequate sterilization of medical equipment in health-care settings; and unscreened blood and blood products. Today, most people become [[infected]] with the [[hepatitis C virus]] by sharing needles or other equipment to inject drugs. Acute [[HCV infection]] is usually [[asymptomatic]], and is only very rarely associated with life-threatening disease. About 15–45% of [[infected]] persons spontaneously clear the [[virus]] within 6 months of [[infection]] without any treatment. The remaining 55–85% of persons will develop chronic [[HCV infection]]. Of those with chronic [[HCV infection]], the risk of [[cirrhosis]] of the liver is 15–30% within 20 years. Hepatitis C can be either “acute” or “chronic.” Possible complication include: [[chronic hepatitis]], [[liver failure]] and [[coma]].


==What is hepatitis?==
==What are the symptoms of Hepatitis C?==
Hepatitis means inflammation of the liver. The liver is a vital part of the body. If it does not work properly, it can cause serious illness. Viral hepatitis is the term used when the hepatitis is caused by a virus. There are several types of viral hepatitis including A, B, C, D and E; the most common types in the United States are hepatitis A, hepatitis B, and hepatitis C. All these viruses affect the liver but are spread in different ways. So the ways to prevent people from getting the virus are different too. Drinking alcohol or taking drugs (whether legal, illegal or prescription) can also cause a type of hepatitis.
The incubation period for hepatitis C is 2 weeks to 6 months. When first infected with the hepatitis C virus many people may not feel ill. Approximately 70%–80% of people with acute hepatitis C do not have any symptoms. Others may find their urine becomes dark and their eyes and their skin may turn yellow (jaundice) or they may experience a minor ‘flu-like’ illness. Other symptoms of acute hepatitis C include:
*[[Fever]]
*[[Fatigue]]
*[[Loss of appetite]]
*[[Nausea]]
*[[Vomiting]]
*[[Abdominal pain]]
*[[Dark urine]]
*Clay-colored bowel movements
*[[Joint pain]]
*[[Jaundice]] (yellow color in the skin or eyes)
These symptoms may disappear within a few weeks, but this does not necessarily mean that the infection has also gone.


Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, hepatitis C was also commonly spread through blood transfusions and organ transplants.  
If you have [[hepatitis]] [[symptoms]], or think you have been put at risk, you should consult your doctor. A [[blood test]] can determine if you have [[hepatitis C]]. When a person has the [[virus]] for more than six months the illness is called '''chronic hepatitis C'''.


Hepatitis C can be either “acute” or “chronic.” Acute hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis C virus. For most people, acute infection leads to chronic infection. Chronic hepatitis C is a serious disease than can result in long-term health problems, or even death.  
Most people with [[chronic hepatitis C]] do not have any [[symptoms]]. However, if a person has been [[infected]] for many years, his or her [[liver]] may be damaged. In many cases, there are no [[symptoms]] of the disease until liver problems have developed. In persons without [[symptoms]], [[hepatitis C]] is often detected during routine [[blood tests≠≠ to measure [[liver function]] and [[liver enzymes]] (protein produced by the liver) level.
The symptoms of [[chronic hepatitis C]] may be:
*Mild to severe [[lethargy]] (tiredness)
*[[Loss of appetite]]
*[[Nausea]] and [[vomiting]]
*Soreness in the upper right part of the belly (under the ribs)
*[[Fever]] and [[flu]]-like symptoms
*[[Joint pain]]
In many cases people who have [[chronic hepatitis C]] may not feel ill.


==How is hepatitis C spread?==
Even if a person with hepatitis C has no symptoms, he or she can still spread the virus to others.
 
==What causes Hepatitis C?==
===Blood===
===Blood===
The hepatitis C virus is present in the blood of an infected person. If infected blood enters another person’s blood stream, that person may get the virus. People can get hepatitis C by:
The [[hepatitis C virus]] is present in the [[blood]] of an [[infected]] person. If [[infected]] blood enters another person’s [[blood stream]], that person may get the [[virus]]. People can get [[hepatitis C]] by:
*sharing drug-injecting equipment such as needles, syringes and spoons.
*Sharing drug-injecting equipment such as needles, syringes and spoons
*tattooing and body piercing using equipment that has not been properly cleaned and sterilised.
*Tattooing and body piercing using equipment that has not been properly cleaned and sterilised
*sharing toothbrushes, razor blades or other similar personal items that could have small amounts of blood on them.
*Sharing toothbrushes, razor blades or other similar personal items that could have small amounts of blood on them
*one person’s blood coming into contact with open cuts on another person.
*One person’s [[blood]] coming into contact with open cuts on another person
*needlestick injuries in the health care setting.
*Needlestick injuries in the health care setting
*In some countries, HCV is transmitted via the transfusion of unscreened blood and blood products;
 
===Mother to Baby===
===Mother to Baby===
Mothers with hepatitis C may on rare occasions pass the virus to their babies during pregnancy, or at the time of birth. Breastfeeding is considered safe and only cracked or bleeding nipples may be a problem.
Mothers with hepatitis C may on rare occasions pass the [[virus]] to their babies during pregnancy, or at the time of birth. Breastfeeding is considered safe and only cracked or bleeding nipples may be a problem.
 
===Sex===
===Sex===
Sexual transmission rates of hepatitis C are very low, but the risk is increased with certain sexual practices or circumstances where there is the possibility of blood-to-blood contact (for example, sex during menstruation and rough sexual practices). The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV.
Sexual transmission rates of hepatitis C are very low, but the risk is increased with certain sexual practices or circumstances where there is the possibility of blood-to-blood contact (for example, sex during menstruation). The risk increases for those who have multiple sex partners, have a [[sexually transmitted disease]], or are infected with [[HIV]].


==What are the symptoms of hepatitis C?==
==Who is at highest risk?==
When first infected with the hepatitis C virus many people may not feel ill. Approximately 70%–80% of people with acute hepatitis C do not have any symptoms. Others may find their urine becomes dark and their eyes and their skin may turn yellow (jaundice) or they may experience a minor ‘flu-like’ illness. Other symptoms of acute hepatitis C include:
Early [[diagnosis]] can prevent health problems that may result from [[infection]], and prevent [[transmission]] of the [[virus]].
*Fever
*Fatigue
*Loss of appetite
*Nausea
*Vomiting
*Abdominal pain
*Dark urine
*Clay-colored bowel movements
*Joint pain
*Jaundice (yellow color in the skin or eyes)
These symptoms may disappear within a few weeks but this does not necessarily mean that the infection has also gone. If you have hepatitis symptoms, or think you have been put at risk, you should consult your doctor. A blood test can determine if you have hepatitis C. When a person has the virus for more than six months the illness is called '''chronic hepatitis C'''. Most people with chronic hepatitis C do not have any symptoms. However, if a person has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, hepatitis C is often detected during routine blood tests to measure liver function and liver enzyme (protein produced by the liver) level.
The symptoms of chronic hepatitis C may be:
*mild to severe lethargy (tiredness),
*loss of appetite,
*nausea and vomiting,
*soreness in the upper right part of the belly (under the ribs),
*fever or flu-like symptoms, or
*pain in the joints.


In many cases people who have chronic hepatitis C may not feel ill. '''Even if a person with hepatitis C has no symptoms, he or she can still spread the virus to others.'''
Some countries recommend [[screening]] for people who may be at increased risk of [[infection]].


==Who is at risk for hepatitis C?==
People in increased risk for [[hepatitis C infection]], include:
Some people are at increased risk for hepatitis C, including:
*Current injection drug users (currently the most common way [[hepatitis C virus]] is spread in the United States)  
*Current injection drug users (currently the most common way hepatitis C virus is spread in the United States)  
*Past injection drug users, including those who injected only one time or many years ago  
*Past injection drug users, including those who injected only one time or many years ago  
*Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)  
*Recipients of donated [[blood]], blood products, and organs (once a common way of [[transmission]] but now rare in the United States since blood [[screening]] became available in 1992)  
*People who received a blood product for clotting problems made before 1987  
*People who received a blood product for clotting problems made before 1987  
*Hemodialysis patients or persons who spent many years on dialysis for kidney failure  
*[[Hemodialysis]] patients or persons who spent many years on [[dialysis]] for [[kidney failure]]
*People who received body piercing or tattoos done with non-sterile instruments  
*People who received body piercing or tattoos done with non-sterile instruments  
*People with known exposures to the hepatitis C virus, such as  
*People with known exposures to the [[hepatitis C virus]], such as healthcare workers
*Healthcare workers injured by needlesticks
*[[HIV]]-infected persons  
*Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
*Children born to mothers [[infected]] with the [[hepatitis C virus]]
*HIV-infected persons  
*Having sexual contact with a person who is infected with the [[hepatitis C virus]]
*Children born to mothers infected with the hepatitis C virus  
*Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person
Less common risks include:
 
*Having sexual contact with a person who is infected with the hepatitis C virus  
==When to seek urgent medical care?==
*Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person  
Talk to your doctor about being tested for hepatitis C if any of the following are true:
*You are a current or former injection drug user, even if you injected only one time or many years ago
*You were treated for a [[blood]] clotting problem before 1987
*You received a [[blood transfusion]] or [[organ transplant]] before July 1992
*You are on long-term [[hemodialysis]] treatment
*You have abnormal liver tests or [[liver disease]]
*You work in healthcare or public safety and were exposed to [[blood]] through a needlestick or other sharp object injury
*You are [[infected]] with [[HIV]]
 
==Diagnosis==
Due to the fact that acute [[HCV infection]] is usually [[asymptomatic]], early [[diagnosis]] of the [[HCV infection]] is rare. In those people who develop chronic [[HCV infection]], the [[infection]] may remain undiagnosed, often until serious liver damage has developed.
 
HCV infection is diagnosed in 2 steps:
 
* [[Screening]] for anti-[[HCV]] [[antibodies]] with a [[serological]] test identifies people who have been [[infected]] with the [[virus]].
 
* If the test is positive for anti-[[HCV]] [[antibodies]], a [[nucleic acid]] test for [[HCV]] [[RNA]] is needed to confirm chronic [[HCV infection]] because about 15–45% of people infected with [[HCV]] spontaneously clear the [[infection]] by a strong [[immune response]] without the need for treatment. Although no longer [[infected]], they will still test positive for anti-[[HCV]] [[antibodies]].
 
After a person has been diagnosed with chronic [[hepatitis C infection]], they should have an assessment of the degree of liver damage ([[fibrosis]] and [[cirrhosis]]). This can be done by [[liver biopsy]] or through a variety of non-invasive tests.
 
In addition, these persons should have a laboratory test to identify the [[genotype]] of the hepatitis C [[strain]]. There are 6 [[genotype]]s of the [[HCV]] and they respond differently to treatment. Furthermore, it is possible for a person to be [[infected]] with more than one genotype. The degree of liver damage and virus [[genotype]] are used to guide treatment decisions and management of the disease.
 
==What to expect (Outlook/Prognosis)?==
[[Chronic hepatitis C]] is a serious disease that can result in long-term health problems, including liver damage, [[liver failure]], [[liver cancer]], or even death.
 
It is the leading cause of [[cirrhosis]] and [[liver cancer]] and the most common reason for [[liver transplantation]] in the United States. Approximately 8,000–10,000 people die every year from [[hepatitis C]] related [[liver disease]].
 
Of every 100 people infected with the [[hepatitis C virus]], about:
*75–85 people will develop chronic hepatitis C virus infection. Of those:
**60–70 people will go on to develop [[chronic liver disease]]
**5–20 people will go on to develop [[cirrhosis]] over a period of 20–30 years
**1–5 people will die from [[cirrhosis]] or [[liver cancer]]
 
Some people who have [[hepatitis C]] choose to make changes to their lives, such as reducing [[alcohol]] intake, maintaining a well balanced diet that is low in fat and considering overall health maintenance.
 
You should also:
* Consult your doctor who will monitor your condition and, if necessary, refer you to a specialist.
* Consider being immunized against other [[hepatitis]] viruses for which there are [[vaccines]] (ie hepatitis A and hepatitis B)
* Completely cover any cut or wound with a waterproof dressing
 
If you have hepatitis C you should not:
*share injecting equipment
*donate blood or body organs
*share personal items such as toothbrushes or razors
 
Although there is no legal obligation to do so, you may wish to discuss your condition with your health care provider (doctor, dentist, naturopath) for optimal health care.
 
==Treatment options==
[[Hepatitis C]] does not always require treatment as the [[immune response]] in some people will clear the [[infection]]. When treatment is necessary, the goal of [[hepatitis C]] treatment is cure. The cure rate depends on several factors including the [[strain]] of the [[virus]] and the type of treatment given. Careful [[screening]] is necessary before starting the treatment to determine the most appropriate approach for the patient.
 
The current standard treatment for [[hepatitis C]] is combination of [[antiviral]] therapy with [[interferon]] and [[ribavirin]], which are effective against all the [[genotype]]s of [[hepatitis]] viruses (pan-genotypic).
 
Unfortunately, [[interferon]] is not widely available globally and it is poorly tolerated in some patients. This means that management of the treatment is complex, and many patients do not finish their treatment. Despite these limitations, [[interferon]] and [[ribavirin]] treatment can be life-saving.


==Diagnosis of Hepatitis C==
Scientific advances have led to the development of new [[antiviral]] drugs for hepatitis C, which are much more effective, safer and better-tolerated than existing therapies.
Having an '''antibody test''' tells you whether or not you have ever been infected with hepatitis C. This test does not tell you whether you still have the hepatitis C virus since antibodies will remain in the blood even if your body has cleared the virus. It may take two to three months (or sometimes longer) from the time of infection before a blood test can detect antibodies to hepatitis C. If you have a positive hepatitis C antibody test, specialized laboratories can do an additional test called hepatitis C PCR to determine if the virus is still present in your body.


==When should I seek urgent medical care?==
These therapies, known as oral ''directly acting antiviral agent'' (DAAs) therapies simplify hepatitis C treatment by significantly decreasing monitoring requirements and by increasing cure rates. Although the production cost of DAAs is low, the initial prices set by companies are very high and likely to make access to these drugs difficult even in high-income countries.
Talk to your doctor about being tested for hepatitis C if any of the following are true:
*You are a current or former injection drug user, even if you injected only one time or many years ago.
*You were treated for a blood clotting problem before 1987.
*You received a blood transfusion or organ transplant before July 1992.
*You are on long-term hemodialysis treatment.
*You have abnormal liver tests or liver disease.
*You work in healthcare or public safety and were exposed to blood through a needlestick or other sharp object injury.
*You are infected with HIV.  


==Treatment Options==
Much needs to be done to ensure that these advances lead to greater access to treatment globally.
There is no medication available to treat acute hepatitis C infection. Doctors usually recommend rest, adequate nutrition, and fluids. People with chronic hepatitis C should be monitored regularly for signs of liver disease and evaluated for treatment. New combination treatment with the medicines pegylated interferon and ribavirin has greatly improved outcomes for people with chronic hepatitis C. These treatments can help decrease inflammation in the liver and can clear the virus in around 50 per cent of people. However, not every person with chronic hepatitis C needs or will benefit from treatment. In addition, the drugs may cause serious side effects in some patients. It is important to talk to your doctor and other support services about treatment options. Some people who have hepatitis C choose to use complementary therapies to manage the side effects of combination medicines.


Approximately 15%–25% of people who get hepatitis C will clear the virus from their bodies without treatment and will not develop chronic infection.
==Possible complications==
Possible [[complications]] of [[hepatitis C]] include:
* [[Chronic hepatitis]]
* [[Liver failure]]
* [[Coma ]]


==Diseases with Similar Symptoms==
==Diseases with Similar Symptoms==
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*[[Hepatitis E]]
*[[Hepatitis E]]


==Where do I find medical care for hepatitis C?==
==Where to find medical care for Hepatitis C?==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|hepatitis c}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating Hepatitis C]
[http://maps.google.com/maps?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|map+top+hospital+Hepatitis C}}}}&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=wl Directions to Hospitals Treating Hepatitis C]


==Prevention==
===Primary prevention===
There is no [[vaccine]] for hepatitis C, therefore prevention of [[HCV infection]] depends upon reducing the risk of exposure to the [[virus]] in health-care settings, in higher risk populations, for example, people who inject drugs, and through sexual contact.


==Prevention==
The following list provides a limited example of [[primary prevention]] interventions recommended by [[WHO]]:
At present there is '''no vaccine''' available to prevent a person from being infected with hepatitis C.
* Hand hygiene: including surgical hand preparation, hand washing and use of gloves
*Do not share personal items such as toothbrushes, razors, nail files or nail scissors, as these can puncture the skin and have small amounts of blood on them.
* Safe handling and disposal of sharps and waste
*If you are involved in body piercing, tattooing, electrolysis or acupuncture, always ensure that any instrument that pierces the skin is sterile.
* Safe cleaning of equipment
*Health care workers are required to follow standard infection control guidelines.
* Testing of donated blood
*Wherever possible, wear single-use gloves if you give someone first aid or clean up blood or body fluids.
* Improved access to safe blood
*You may wish to consider the benefits of safe sex practices (eg, using condoms and dams with lubricant) to protect you and your partner from a range of sexually transmissible infections, eg chlamydia. If blood is present during sex, the risk of spreading hepatitis C increases and safe sex practices may be advisable. Talk to your doctor if you are unsure.
* Training of health personnel
===For people who inject drugs:===
* Do not share personal items such as toothbrushes, razors, nail files or nail scissors, as these can puncture the skin and have small amounts of blood on them
* If you are involved in body piercing, tattooing, electrolysis or acupuncture, always ensure that any instrument that pierces the skin is sterile
* You may wish to consider the benefits of safe sex practices (eg, using condoms and dams with lubricant) to protect you and your partner from a range of sexually transmissible [[infections]], eg chlamydia. If blood is present during sex, the risk of spreading [[hepatitis C]] increases and safe sex practices may be advisable. Talk to your doctor if you are unsure.
 
====For people who inject drugs====
*Always wash your hands before and after injecting.
*Always wash your hands before and after injecting.
*Never share needles and syringes. Never share other equipment such as spoons, swabs, filters, tourniquets and water as they can also be contaminated.
*Never share needles and syringes. Never share other equipment such as spoons, swabs, filters, tourniquets and water as they can also be contaminated.
===Cleaning and removal of blood spills:===
 
====Cleaning and removal of blood spills====
*Wear single-use gloves and use paper towels to mop up the blood spill and dispose of used paper towels in a plastic bag.
*Wear single-use gloves and use paper towels to mop up the blood spill and dispose of used paper towels in a plastic bag.
*Wash area with warm water and detergent, rinse and dry.
*Wash area with warm water and detergent, rinse and dry.
Line 108: Line 170:
*Wash hands in warm soapy water and dry thoroughly.
*Wash hands in warm soapy water and dry thoroughly.


==Outlook==
===Secondary and tertiary prevention===
Chronic hepatitis C is a serious disease that can result in '''long-term health problems, including liver damage, liver failure, liver cancer, or even death'''. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 8,000–10,000 people die every year from hepatitis C related liver disease.
For people [[infected]] with the [[hepatitis C virus]], [[WHO]] recommends:
 
* Education and counselling on options for care and treatment
Of every 100 people infected with the hepatitis C virus, about:
* Immunization with the hepatitis A and B vaccines to prevent coinfection from these hepatitis viruses to protect their liver
*75–85 people will develop chronic hepatitis C virus infection; of those,
* Early and appropriate medical management including [[antiviral]] therapy if appropriate
**60–70 people will go on to develop chronic liver disease
* Regular monitoring for early [[diagnosis]] of [[chronic liver disease]]
**5–20 people will go on to develop cirrhosis over a period of 20–30 years
**1–5 people will die from cirrhosis or liver cancer
 
Some people who have hepatitis C choose to make changes to their lives, such as reducing alcohol intake, maintaining a well balanced diet that is low in fat and considering overall health maintenance.
You should also:
*consult your doctor who will monitor your condition and, if necessary, refer you to a specialist.
*consider being immunised against other hepatitis viruses for which there are vaccines (ie hepatitis A and hepatitis B).
*completely cover any cut or wound with a waterproof dressing.
If you have hepatitis C you should not:
*share injecting equipment,
*donate blood or body organs, or
*share personal items such as toothbrushes or razors.
Although there is no legal obligation to do so, you may wish to discuss your condition with your health care provider, eg doctor, dentist, naturopath, for optimal health care.


==Sources==
==Sources==
*[http://www.cdc.gov/hepatitis/HepatitisC.htm Centers for Disease Control and Prevention]
*[http://www.cdc.gov/hepatitis/HepatitisC.htm Centers for Disease Control and Prevention]
*[http://www.health.vic.gov.au/__data/assets/pdf_file/0003/19929/HS357-Hep-C-DL-book_5-April04-UPDATE.pdf Victorian Government Health Information]
*[http://www.health.vic.gov.au/__data/assets/pdf_file/0003/19929/HS357-Hep-C-DL-book_5-April04-UPDATE.pdf Victorian Government Health Information]
*[http://www.who.int/en/ World Health Organization]
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Latest revision as of 22:05, 29 July 2020

For the WikiDoc page for this topic, click here

Hepatitis C

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Hepatitis C?

What to expect (Outlook/Prognosis)?

Possible complications

Prevention

Hepatitis C On the Web

Ongoing Trials at Clinical Trials.gov

Images of Hepatitis C

Videos on Hepatitis C

FDA on Hepatitis C

CDC on Hepatitis C

Hepatitis C in the news

Blogs on Hepatitis C

Directions to Hospitals Treating Hepatitis C

Risk calculators and risk factors for Hepatitis C

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Hepatitis C is a contagious liver disease caused by the hepatitis C virus: the virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness, lasting a few weeks to a serious, lifelong illness. The hepatitis C virus is a bloodborne virus and the most common modes of infection are through unsafe injection practices; inadequate sterilization of medical equipment in health-care settings; and unscreened blood and blood products. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs. Acute HCV infection is usually asymptomatic, and is only very rarely associated with life-threatening disease. About 15–45% of infected persons spontaneously clear the virus within 6 months of infection without any treatment. The remaining 55–85% of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis of the liver is 15–30% within 20 years. Hepatitis C can be either “acute” or “chronic.” Possible complication include: chronic hepatitis, liver failure and coma.

What are the symptoms of Hepatitis C?

The incubation period for hepatitis C is 2 weeks to 6 months. When first infected with the hepatitis C virus many people may not feel ill. Approximately 70%–80% of people with acute hepatitis C do not have any symptoms. Others may find their urine becomes dark and their eyes and their skin may turn yellow (jaundice) or they may experience a minor ‘flu-like’ illness. Other symptoms of acute hepatitis C include:

These symptoms may disappear within a few weeks, but this does not necessarily mean that the infection has also gone.

If you have hepatitis symptoms, or think you have been put at risk, you should consult your doctor. A blood test can determine if you have hepatitis C. When a person has the virus for more than six months the illness is called chronic hepatitis C.

Most people with chronic hepatitis C do not have any symptoms. However, if a person has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, hepatitis C is often detected during routine [[blood tests≠≠ to measure liver function and liver enzymes (protein produced by the liver) level. The symptoms of chronic hepatitis C may be:

In many cases people who have chronic hepatitis C may not feel ill.

Even if a person with hepatitis C has no symptoms, he or she can still spread the virus to others.

What causes Hepatitis C?

Blood

The hepatitis C virus is present in the blood of an infected person. If infected blood enters another person’s blood stream, that person may get the virus. People can get hepatitis C by:

  • Sharing drug-injecting equipment such as needles, syringes and spoons
  • Tattooing and body piercing using equipment that has not been properly cleaned and sterilised
  • Sharing toothbrushes, razor blades or other similar personal items that could have small amounts of blood on them
  • One person’s blood coming into contact with open cuts on another person
  • Needlestick injuries in the health care setting
  • In some countries, HCV is transmitted via the transfusion of unscreened blood and blood products;

Mother to Baby

Mothers with hepatitis C may on rare occasions pass the virus to their babies during pregnancy, or at the time of birth. Breastfeeding is considered safe and only cracked or bleeding nipples may be a problem.

Sex

Sexual transmission rates of hepatitis C are very low, but the risk is increased with certain sexual practices or circumstances where there is the possibility of blood-to-blood contact (for example, sex during menstruation). The risk increases for those who have multiple sex partners, have a sexually transmitted disease, or are infected with HIV.

Who is at highest risk?

Early diagnosis can prevent health problems that may result from infection, and prevent transmission of the virus.

Some countries recommend screening for people who may be at increased risk of infection.

People in increased risk for hepatitis C infection, include:

  • Current injection drug users (currently the most common way hepatitis C virus is spread in the United States)
  • Past injection drug users, including those who injected only one time or many years ago
  • Recipients of donated blood, blood products, and organs (once a common way of transmission but now rare in the United States since blood screening became available in 1992)
  • People who received a blood product for clotting problems made before 1987
  • Hemodialysis patients or persons who spent many years on dialysis for kidney failure
  • People who received body piercing or tattoos done with non-sterile instruments
  • People with known exposures to the hepatitis C virus, such as healthcare workers
  • HIV-infected persons
  • Children born to mothers infected with the hepatitis C virus
  • Having sexual contact with a person who is infected with the hepatitis C virus
  • Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person

When to seek urgent medical care?

Talk to your doctor about being tested for hepatitis C if any of the following are true:

  • You are a current or former injection drug user, even if you injected only one time or many years ago
  • You were treated for a blood clotting problem before 1987
  • You received a blood transfusion or organ transplant before July 1992
  • You are on long-term hemodialysis treatment
  • You have abnormal liver tests or liver disease
  • You work in healthcare or public safety and were exposed to blood through a needlestick or other sharp object injury
  • You are infected with HIV

Diagnosis

Due to the fact that acute HCV infection is usually asymptomatic, early diagnosis of the HCV infection is rare. In those people who develop chronic HCV infection, the infection may remain undiagnosed, often until serious liver damage has developed.

HCV infection is diagnosed in 2 steps:

After a person has been diagnosed with chronic hepatitis C infection, they should have an assessment of the degree of liver damage (fibrosis and cirrhosis). This can be done by liver biopsy or through a variety of non-invasive tests.

In addition, these persons should have a laboratory test to identify the genotype of the hepatitis C strain. There are 6 genotypes of the HCV and they respond differently to treatment. Furthermore, it is possible for a person to be infected with more than one genotype. The degree of liver damage and virus genotype are used to guide treatment decisions and management of the disease.

What to expect (Outlook/Prognosis)?

Chronic hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death.

It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 8,000–10,000 people die every year from hepatitis C related liver disease.

Of every 100 people infected with the hepatitis C virus, about:

  • 75–85 people will develop chronic hepatitis C virus infection. Of those:

Some people who have hepatitis C choose to make changes to their lives, such as reducing alcohol intake, maintaining a well balanced diet that is low in fat and considering overall health maintenance.

You should also:

  • Consult your doctor who will monitor your condition and, if necessary, refer you to a specialist.
  • Consider being immunized against other hepatitis viruses for which there are vaccines (ie hepatitis A and hepatitis B)
  • Completely cover any cut or wound with a waterproof dressing

If you have hepatitis C you should not:

  • share injecting equipment
  • donate blood or body organs
  • share personal items such as toothbrushes or razors

Although there is no legal obligation to do so, you may wish to discuss your condition with your health care provider (doctor, dentist, naturopath) for optimal health care.

Treatment options

Hepatitis C does not always require treatment as the immune response in some people will clear the infection. When treatment is necessary, the goal of hepatitis C treatment is cure. The cure rate depends on several factors including the strain of the virus and the type of treatment given. Careful screening is necessary before starting the treatment to determine the most appropriate approach for the patient.

The current standard treatment for hepatitis C is combination of antiviral therapy with interferon and ribavirin, which are effective against all the genotypes of hepatitis viruses (pan-genotypic).

Unfortunately, interferon is not widely available globally and it is poorly tolerated in some patients. This means that management of the treatment is complex, and many patients do not finish their treatment. Despite these limitations, interferon and ribavirin treatment can be life-saving.

Scientific advances have led to the development of new antiviral drugs for hepatitis C, which are much more effective, safer and better-tolerated than existing therapies.

These therapies, known as oral directly acting antiviral agent (DAAs) therapies simplify hepatitis C treatment by significantly decreasing monitoring requirements and by increasing cure rates. Although the production cost of DAAs is low, the initial prices set by companies are very high and likely to make access to these drugs difficult even in high-income countries.

Much needs to be done to ensure that these advances lead to greater access to treatment globally.

Possible complications

Possible complications of hepatitis C include:

Diseases with Similar Symptoms

Where to find medical care for Hepatitis C?

Directions to Hospitals Treating Hepatitis C

Prevention

Primary prevention

There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings, in higher risk populations, for example, people who inject drugs, and through sexual contact.

The following list provides a limited example of primary prevention interventions recommended by WHO:

  • Hand hygiene: including surgical hand preparation, hand washing and use of gloves
  • Safe handling and disposal of sharps and waste
  • Safe cleaning of equipment
  • Testing of donated blood
  • Improved access to safe blood
  • Training of health personnel
  • Do not share personal items such as toothbrushes, razors, nail files or nail scissors, as these can puncture the skin and have small amounts of blood on them
  • If you are involved in body piercing, tattooing, electrolysis or acupuncture, always ensure that any instrument that pierces the skin is sterile
  • You may wish to consider the benefits of safe sex practices (eg, using condoms and dams with lubricant) to protect you and your partner from a range of sexually transmissible infections, eg chlamydia. If blood is present during sex, the risk of spreading hepatitis C increases and safe sex practices may be advisable. Talk to your doctor if you are unsure.

For people who inject drugs

  • Always wash your hands before and after injecting.
  • Never share needles and syringes. Never share other equipment such as spoons, swabs, filters, tourniquets and water as they can also be contaminated.

Cleaning and removal of blood spills

  • Wear single-use gloves and use paper towels to mop up the blood spill and dispose of used paper towels in a plastic bag.
  • Wash area with warm water and detergent, rinse and dry.
  • Place used gloves into a plastic bag, then seal and dispose of the plastic bag in a rubbish bin.
  • Wash hands in warm soapy water and dry thoroughly.

Secondary and tertiary prevention

For people infected with the hepatitis C virus, WHO recommends:

  • Education and counselling on options for care and treatment
  • Immunization with the hepatitis A and B vaccines to prevent coinfection from these hepatitis viruses to protect their liver
  • Early and appropriate medical management including antiviral therapy if appropriate
  • Regular monitoring for early diagnosis of chronic liver disease

Sources

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